喘之一证,已得大补而平,可见肝脾肾三
经亏之已极,姑置勿论。现下脉芤且弦,其名为革,以昭血络空虚元气难摄之意。夫惟元气
难摄,所有温邪下注为便溏,外走为浮肿,上逆为咳痰;甚至阴络伤、血内溢之下,更有阳
络伤、血外溢之症。似此中虚少纳者,遇之窃恐不堪磨耐,仍起风波而败,不可忽略。
制川附七分(青盐下拌) 大生地(二钱) 白芍(一钱) 阿胶(一钱五分) 炙草(四分) 人参
(七分) 五味子(七分) 麦冬(一钱五分) 牡蛎(一两) 伏龙肝(一两) 乌梅(一钱)
湿有五肥,人之湿多起于脾。脾主湿,又湿主土,土气不旺,湿邪无路可出,出则变而
为痰,化而为热,所为湿生痰,痰生热是也。湿热痰体已既有年,姑置勿论,且论病经两候痛
泻起因,继寒热往来,一日日三度发其间,呃忒频频,七日而止,显系冷风外感,内从少阳
而入,里气不纳,上逆冲激,出入无定使然。当时汗出太多,虽有口舌呕恶等症,却难和以小
柴胡汤。现下汗已不少,吐亦未除,下亦通矣,三法自尽,而疟疾仍作,胸前痞闷,右脉大虚,
邪气还盛,汗吐下三法既不可施,惟有和寒温三例尚可以行。常见丹田有热,胸上有寒,白
胎滑者,仲景曾有一方,喻氏师之以为和上下法之计;又见汗吐下三法之后,胸前作痞,噫
气不舒者,用旋复代赭石汤,通其阳,镇其逆。俾得呃不再起,想亦未始不合也。然以此治法
不独为新病而设,即旧时之湿热生痰亦与焉。和方之制,和其不和也,不和于已虚之后。窃
恐虚波暗起,不可忽略。候诸高明先生政。
川连 干姜 炙草 复花 赭石 人参 半夏 桂枝 茯苓 陈皮 白芍 草果仁 生姜 红枣 附子
(青盐拌炒) 生于术(姜水拌炒焦)
喘证这一病症,在得到大补治疗后已经平息,可见肝、脾、肾三经的亏损已达到极点,暂且搁置不论。目前的脉象芤且弦,名为革脉,这昭示了血络空虚、元气难以固摄的意涵。正因为元气难以固摄,温邪下注导致大便溏薄,外溢肌肤导致浮肿,上逆导致咳嗽痰多;甚至在下部阴络受损、血液内溢之后,更有上部阳络受损、血液外溢的症状。像这样中焦虚弱、食欲不佳的患者,遇到这种情况,我私下里恐怕其身体难以承受这种磨难,仍会引发病情反复而败坏,不可掉以轻心。
制川附子七分(用青盐拌炒后下) 大生地二钱 白芍一钱 阿胶一钱五分 炙甘草四分 人参七分 五味子七分 麦冬一钱五分 牡蛎一两 伏龙肝一两 乌梅一钱
湿有五种分类,人的湿气多源于脾脏。脾主运化水湿,湿又对应五行中的土,若土气不旺盛,湿气便无路可出,排出体外则转化为痰,进一步化为热,这就是所谓的“湿生痰,痰生热”。湿热痰浊的体质既然已经存在多年,暂且搁置不论,现在来讨论发病经过两候后出现腹痛腹泻的原因,随后出现寒热往来,一天发作三次,其间伴有频繁的呃逆,持续七天才停止,这明显是冷风外感,从少阳经内部侵入,里气不能纳受,向上逆冲激荡,出入无定所致。当时出汗过多,虽然伴有口舌干燥、呕吐恶心等症状,却难以使用小柴胡汤进行和解。目前汗出已不少,呕吐也未消除,大便也已通畅,汗、吐、下三种治法均已尝试过,但疟疾仍然发作,胸前痞闷不适,右脉大虚,邪气依然强盛,既然汗、吐、下三法均不可再用,唯有调和寒温的法则还可以施行。常常见到丹田有热、胸上有寒,舌苔白滑的情况,张仲景曾有一方,喻嘉言先生效法此方作为调和上下之法;又见到在汗、吐、下三法之后,胸前出现痞满,嗳气不畅的情况,使用旋复代赭石汤,以通阳降逆。使得呃逆不再发作,想来也是合乎医理的。然而以此种治法不仅针对新病而设,对于旧时的湿热生痰也同样适用。和方的制作,旨在调和不和的状态,特别是在正气已虚之后的不调和。私下里担心虚损的波澜暗中兴起,不可掉以轻心。等候各位高明先生指正。
黄连 干姜 炙甘草 旋复花 代赭石 人参 半夏 桂枝 茯苓 陈皮 白芍 草果仁 生姜 红枣 附子(青盐拌炒) 生白术(姜水拌炒至焦)
The syndrome of asthma (Chuan, panting/asthma) has been stabilized after receiving substantial tonification, indicating that the deficiency in the Liver, Spleen, and Kidney meridians has reached an extreme degree; this shall be set aside for now. The current pulse is hollow (Kou) and taut (Xian), named "Ge" (Leather pulse), which signifies emptiness in the blood collaterals and the difficulty of Yuan Qi (Original Qi) to hold fast. Precisely because Yuan Qi is difficult to retain, warm pathogenic factors sinking downward cause loose stools, spreading outward causes edema, and reversing upward causes cough with phlegm; furthermore, below, injury to Yin collaterals leads to internal hemorrhage, and above, injury to Yang collaterals leads to external hemorrhage. For a patient with such middle Jiao deficiency and poor appetite, encountering this condition, I fear their body may not endure the strain, potentially leading to recurrence and deterioration; it must not be neglected.
Prepared Chuan Fuzi (Aconiti Lateralis Radix Praeparata) 7 fen (decocted last with Qingyan/Salt); Da Shengdi (Rehmanniae Radix Recens) 2 qian; Bai Shao (Paeoniae Radix Alba) 1 qian; E'jiao (Colla Corii Asini) 1.5 qian; Zhi Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 4 fen; Ren Shen (Ginseng Radix et Rhizoma) 7 fen; Wu Wei Zi (Schisandrae Chinensis Fructus) 7 fen; Mai Dong (Ophiopogonis Radix) 1.5 qian; Mu Li (Concha Ostreae) 1 liang; Fulonggan (Cauda Termitarii) 1 liang; Wu Mei (Mume Fructus) 1 qian.
Dampness is categorized into five types; human dampness mostly originates from the Spleen. The Spleen governs dampness, and dampness corresponds to the Earth element. If Earth Qi is not vigorous, dampness has no outlet; when expelled, it transforms into Phlegm, and further transforms into Heat. This is what is meant by "Dampness generates Phlegm, Phlegm generates Heat." Since the constitution of Damp-Heat and Phlegm has existed for years, let us set that aside for now and discuss the onset of abdominal pain and diarrhea after two periods (Hou), followed by alternating chills and fever, occurring three times a day, accompanied by frequent hiccup (E Te), lasting seven days until cessation. This clearly indicates cold wind external contraction entering internally via the Shaoyang meridian, where interior Qi fails to receive, causing upward reversal and agitation, resulting in irregular entry and exit. At that time, sweating was excessive; although symptoms such as dry mouth and tongue, vomiting, and nausea were present, Xiao Chai Hu Tang (Minor Bupleurum Decoction) could hardly be used for harmonization. Currently, sweating is profuse, vomiting persists, and bowel movements are unobstructed; the methods of sweating, vomiting, and purging have all been exhausted, yet malaria (Nue Ji) still occurs, with chest fullness and oppression, and the right pulse is greatly deficient while pathogenic factors remain strong. Since the methods of sweating, vomiting, and purging cannot be applied, only the method of harmonizing Cold and Warmth can be employed. It is commonly seen that there is heat in the Dantian and cold in the chest, with a white, slippery tongue coating; Zhang Zhongjing once prescribed a formula, which Master Yu (Yu Jia Yan) adopted as a method to harmonize the upper and lower. Furthermore, after the methods of sweating, vomiting, and purging, if chest fullness and discomfort with belching occur, Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction) is used to unblock Yang and suppress rebellion, so that hiccups do not recur, which I believe is also appropriate. However, this treatment method is designed not only for new diseases but also addresses the old Damp-Heat generating Phlegm. The preparation of the Harmonizing Formula aims to harmonize disharmony, specifically after the body has become deficient. I privately fear that waves of deficiency may rise secretly; it must not be neglected. Awaiting correction from distinguished gentlemen.
Huang Lian (Coptidis Rhizoma); Gan Jiang (Zingiberis Rhizoma); Zhi Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle); Xuan Fu Hua (Inulae Flos); Zhe Shi (Haematitum); Ren Shen (Ginseng Radix et Rhizoma); Ban Xia (Pinelliae Tuber); Gui Zhi (Ramulus Cinnamomi); Fu Ling (Poria); Chen Pi (Citri Reticulatae Pericarpium); Bai Shao (Paeoniae Radix Alba); Cao Guo Ren (Tsaoko Fructus); Sheng Jiang (Zingiberis Rhizoma Recens); Hong Zao (Jujubae Fructus); Fu Zi (Aconiti Lateralis Radix Praeparata, stir-fried with Salt); Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried with Ginger Water until scorched).